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Orthostatic Hypotension in Asymptomatic Patients with Chronic Kidney Disease

1
Family Medicine Unit, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, ul. Warszawska 30, 10-082 Olsztyn, Poland
2
II Clinical Department of Cardiology and Internal Medicine, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, ul. Warszawska 30, 10-082 Olsztyn, Poland
3
Cardiac Diagnostic Unit, II Department of Cardiology, Medical University of Gdańsk, ul. Mariana Smoluchowskiego 17, 80-214 Gdańsk, Poland
4
Clinical Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, ul. Dębinki 7, 80-211 Gdańsk, Poland
*
Author to whom correspondence should be addressed.
Medicina 2019, 55(4), 113; https://doi.org/10.3390/medicina55040113
Received: 17 January 2019 / Revised: 12 April 2019 / Accepted: 17 April 2019 / Published: 20 April 2019
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Abstract

Background and objective: Orthostatic hypotension (OH) is a decrease in systolic blood pressure (BP) of 20 mm Hg and in diastolic BP of 10 mm Hg when changing the position from lying to standing. Arterial hypertension (AH), comorbidities and polypharmacy contribute to its development. The aim was to assess the presence of OH and its predictors in asymptomatic chronic kidney disease (CKD) patients. Material and methods: 45 CKD patients with estimated glomerular filtration rate (eGFR) ≤ 60 mL/min/1.73 m2 (CKD+) were examined for signs of OH and its predictors. The results were compared with the control group of 22 patients with eGFR > 60 mL/min/1.73 m2 (CKD–). Asymptomatic patients without ischemic heart disease and previous stroke were qualified. Total blood count, serum creatinine, eGFR, urea, phosphates, calcium, albumins, parathyroid hormone, uric acid, C reactive protein, N-terminal pro b-type natriuretic peptide, lipid profile, and urine protein to creatinine ratio were assessed. Simultaneously, patients underwent echocardiography. To detect OH, a modified Schellong test was performed. Results: OH was diagnosed in 17 out of 45 CKD+ patients (average age 69.12 ± 13.2) and in 8 out of 22 CKD– patients (average age 60.50 ± 14.99). The CKD+ group demonstrated significant differences on average values of systolic and diastolic BP between OH+ and OH– patients, lower when standing. In the eGFR range of 30–60 mL/min/1.73 m2 correlation was revealed between OH and β-blockers (p = 0.04), in the entire CKD+ group between β-blockers combined with diuretics (p = 0.007) and ACE-I (p = 0.033). Logistic regression test revealed that chronic heart failure (CHF, OR = 15.31), treatment with β-blockers (OR = 13.86) were significant factors influencing the presence of OH. Conclusions: Predictors of OH in CKD may include: CHF, treatment with β-blockers, combined with ACE-I and diuretics. View Full-Text
Keywords: orthostatic hypotension; chronic kidney disease orthostatic hypotension; chronic kidney disease
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Januszko-Giergielewicz, B.; Gromadziński, L.; Dudziak, M.; Dębska-Ślizień, A. Orthostatic Hypotension in Asymptomatic Patients with Chronic Kidney Disease. Medicina 2019, 55, 113.

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